Provider Demographics
NPI:1366994303
Name:DHALIWAL, HARDEV SINGH
Entity type:Individual
Prefix:
First Name:HARDEV
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 RED RIBBONS LN
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7926
Mailing Address - Country:US
Mailing Address - Phone:209-900-4646
Mailing Address - Fax:
Practice Address - Street 1:1538 RED RIBBONS LN
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7926
Practice Address - Country:US
Practice Address - Phone:209-900-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse